Intraoral Lesions Following Nose and Nasolabial Fold Augmentation Using Hyaluronic Acid/Poly-l-Lactic Acid Fillers: A Case Report and Literature Review.

Vascular complications after facial filling with hyaluronic acid/poly-l-lactic acid (HA/PLLA) composite fillers are rare. Herein, the authors report a case of vascular occlusion after nose and nasolabial fold augmentation with HA/PLLA that resulted in necrosis of the gingival papilla and unilateral hard palate mucosa and pulpitis. To explain the pathogenesis of necrosis of the gingival papilla and unilateral hard palate mucosa, the authors hypothesized that an embolus was accidentally injected into the infraorbital artery and nasal septum branch of the upper lip artery and subsequently flowed into the branches of the great palatine artery through the abundant vascular anastomoses. Regarding the pathophysiology of the pulpitis, the authors presumed that bacteria or an embolus was injected into the infraorbital artery and subsequently entered the superior and inferior alveolar arteries through the maxillary artery, resulting in pulpitis. After receiving hyaluronidase injections, the patient's prognosis was favorable. In addition to being aware of the risk of embolism of the occult lesion created by using an HA/PLLA composite, surgeons should be knowledgeable about the anatomy of the nose and nasolabial fold. In cases of vascular embolization, hyaluronidase should be promptly administered in appropriate amounts at the filling injection site. To prevent exacerbation of the mucosal ischemia, small-volume, high-concentration, multipoint injections into the hard palate mucosa are advised.